The FDA has created a self inflicked wound to cronic pain suffers
through out country, once again, greed and bad Doctors are the
problem. They have yet to do more than make life of valid cronic
patients, who require these medications, to function on a daily
basis suffer and injustly slap the constant threat of FDA or DEA
action on the caregivers who monitor or treat with &quot;this class of
action&quot;, is not acceptable. The FDA created this problem by putting
a Greed value on this class of treatment and until they figure out
how to let the Doctors, regulate out the bad apples, this will get
much worse. Once again it is all about MONEY..

Carol Corbitt

09/10/13

I believe I saw a report on your site about workman compensation insurance companies pushing the use of these drugs in lieu of expensive diagnostic tests. I believe I haven't two victims of this practice. Has there been further investigation of this problem?.

Honest thought

09/10/13

Cancer pain is not the only severe continual pain. There are many other medical issues that may require a patient
to use around the clock opioids like Fentanyl, OxyContin etc. Pain management ought to be done on an individual
basis not a blanket regulation. The fact that there are many practitioners who won't prescribe these medications for
any reason only ends up hurting patients. In order for some people to be functional in society using these meds in
a responsible way is an important factor to consider. Refill guidelines, patient doctor communication, and other
practices are necessary, however the bad reputation of this class of pharmaceuticals is causing problems more for
valid users than recreational ones. Many patients are ostracized and receive a lower level of care when utilizing
this type of pain control. They are often questioned in a demeaning way by other physicians, are more likely to
have other health issues brushed off and thought of as addicts when that is not the case. It is a sad day in
medicine when a patient cannot recieve adequate pain control because of a medication they use as prescribed.
The unfortunate use of these medications in people without valid medical necessity is terrible, but lets find a way to
work with that population differently. Not by punishing others who are following all the rules. Villafying the meds
doesn't fix anything. Go to the source of the problem..

DeeDee

09/10/13

A Tricky One - whichever way you view it - and guaranteed to
disturb the sleep of many a GP and Chronic Pain Sufferer.
No doubt those who insist it is their God-given duty to protect
patients from themselves will one day experience what it is like to
live on the other side of the FDA Fence, where patients are Human
and alive, not mere statistics..

william fowkes

09/10/13

The "War on Drugs" continues. Though the 21st amendment to the
constitution repealed prohibition, we did not learn from that
disaster. If we tried to declare the "War" over, the very act would
decimate the economy with so many governmental jobs lost. As a
hospice physician, I can do what is needed. However, I have dealt
with those, in the past, who have had all that allopathic medicine
has to offer and still suffer. Often, these folks have tendencies
which are associated with potential "drug abuse" as defined by
those warriors. They can be helped and appropriate long term opiode
therapy is about their last option..

traindoc

09/10/13

The amount of these meds prescribed is out of sight!.

bth

09/10/13

I must agree with
others that point
out the only losers
in this are those of
us with chronic
pain. TENS, SCS,
trigger point
injections,
acupuncture all have
failed to bring me
relief. I wonder if
any of these
physicians have
tried to live with
chronic pain?.

christie t.

09/10/13

Does anyone else find it curious that this new attention to long
term opiod medication by the FDA coincides with the ACA/obamacare
about to be enacted? Could it be that the expense of some of these
medications is considered to high and now they don't want to pay for
it? I know mine are expensive because I pay for them
(patches)myself. This is all that works for me adequately, and I say
adequately because I still live with pain but at a more acceptable
level most days. I too signed a contract with my Doc. as well as
undergo random tox screens which are extremely expensive. The people
who are misusing their meds would not do this and isn't that who the
FDA should really be concerned about?.

PainDoc

09/10/13

I'm confused. How
is Michael von Korff
who is obviously not
a physician a member
of Physicians for
Responsible Opioid
Prescribing?
Apparently the name
of the group is
false one..

Kevin Witbrodt, PharmD

09/10/13

Alright, first
everyone needs to
calm down. This is a
";label" change. This
means that doctors
will still be able
to prescribe these
medications
"off-label" as MDs
have full
prescribing
authority and can
write medications
for "off-label"
indications which
pharmacists can
fill. Second, it's
true there are many
causes for chronic
pain that isn't just
cancer, often that
gets slapped in as
the primary example,
but even so, opioids
(even long-acting)
are not the
first-line form of
treatment for some
types of pain.
With any form of
pain, there is a
step process (WHO
Pain Ladder) that
every MD should
take, and every
pharmacist should
look for, before a
long-acting opioid
is even thought of.
This is actually
already in the label
for fentanyl but no
one gets upset about
that?
I believe this
change is not a real
obstacle to the MDs
who know how to
treat chronic pain
and the pharmacists
who fill these RXs
on a monthly
basis--lets remember
that usually
patients treated
with chronic pain
must fill at ONE
pharmacy as part of
a treatment
agreement).
Please everyone lets
take this "label"
change as a
reminder that
long-acting opioids
or short-acting ones
are not always the
answer to chronic
pain. For example,
Cymbalta, physical
therapy, Neurontin,
Lyrica, Savella,
meditation,
breathing exercises,
biofeedback--just to
name a few are all
choices depending on
the type of pain.
These all have
either labeled or
unlabeled uses for
chronic pain. This
is what the FDA is
getting at--MDs who
don't really know
what they are doing
and just writing MS
Contin or Oxycontin
for a patient who
has only tried
tramadol for one
month or prescribing
opioids for
neuropathic pain or
arthritis.
Above all, I don't
see this making
chronic pain
patients getting
their medications
that they truely
need difficult. What
everyone needs to
think about is what
was mentioned a
while back about
making Schedule
III-IV medications
having no refills
allowed!.

Donna FFPCAN

09/11/13

For more information on this subject, I am posting a link. The FDA
is not limiting these meds to only severe pain. This will be
individualized care and need for patients that need around the
clock pain that IR meds and non opioids do not relieve . It stated
even those with fibro that only opiates LA/ ER meds help their pain
is accepted by your doctors discretion.
Please read this for yourself.
http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/ucm363722
.htm Find the section and read it all..

DrGMG

09/11/13

When you read that 80-90% of the hydrocodone and oxycodone made in
the whole world is consumed in the USA you know we have a huge
problem. People from other countries suffer from chronic pain too,
personally I do not like or believe in opioids in chronic non
cancer/terminal pain..

nancy f

09/11/13

Rates of Neonatal Abstinence Syndrome (the result of infants born to opioid-dependent women) have skyrocketed
in this country (and others) in the last decade. In some states, the incidence of NAS has increased tenfold. Direct
Medicare costs are estimated at $78 million per year related to increased length of stay and medical care for
affected infants. Indirect costs include pain and suffering, family disruption, child protective services, and the need
for support and intervention services in the home. The incidence of NAS is directly proportionate to kilos of
opioids/opiates sold. While these drugs have legitimate applications for treatment of pain, over-prescribing and
misuse have led to an epidemic of drug-exposed infants. As an example of careless prescribing practices, two
acquaintances, both healthy with no underlying medical problems, recently had minor oral surgery in different
states and by two different providers and were each prescribed a 30 day supply of Vicodin..

Janice Reynolds RN, BC, OCN, CHPN

09/11/13

It is hard to know what to say-yes this ruling will not stop
providers from prescribing but what it does is continue to “taint”
the use of opioids (and upping the ante as well) and disrespects
those with persistent pain. I say disrespects those with
persistent (chronic) pain because the implication is there they are
essentially drug seekers;
"for the management of pain severe enough to require daily, around-
the-clock opioid treatment and for which alternative treatments are
inadequate." The new labeling emphasizes first considering
potentially less addictive measures.
Most people with persistent pain have done that or as much as their
insurances will allow. Lack insurance also hinders use of
alternative and non-pharmaceutical interventions as most are costly
(and ACA will not be much help with this as not all states have
agreed to the expansion of Medicaid and many insurance policies
will have undoable deductibles in order to afford premiums). In
actuality, a pain plan should include opioids (If needed), adjuvant
medication to decrease the dose of opioids needed, as well as non-
pharmaceutical interventions and psycho-social support.
The bigger problem here is how many providers still equate chronic
pain with malingering, drug seeking, and dishonesty. There are a
couple of comments here where that stigma is evident. It remains
very hard for many people with pain to find a provider to even care
for them let alone truly help them with their pain. I have been a
pain management nurse for many years and only lately come to the
role of someone with persistent pain. As a Pain Advocate horror
stories abound; the prejudice against people with persistent pain
remains strong among many physicians and nurses (“She likes her
pain medicine a little too much”).
The terms mild, moderate, and severe should not be used related to
pain as one person’s severe can be another’s mild and no second
person (provider) can determine what it is-that leads to under
treatment as well as overtreatment. The pain scale was never
designed for determining how to medicate but rather how the pain
feels to the patient and whether interventions were effective.
Neither is the terms differing Chronic from cancer pain. There are
no studies to show people with cancer experience pain differently
or that cancer related pain is only justifiable because the person
has cancer (some cancer survivors are finding this out already when
they no longer can obtain medication for their cancer or cancer
treatment related pain). Many different pain syndromes exist and
people experiencing the resulting pain can have their lives
destroyed without effective treatment. Pain is pain and trying to
keep treatment to only a few is morally wrong..

lisa w

09/11/13

I'm a MH clinician who sees many people suffering with opioid
addiction problems (which includes its own devastating pain and
suffering to them and their families, and is lethal to many), and
I'm also the family member of a person living with chronic physical
pain who takes opioids every day and does not abuse them. I have
seen both sides. And I have read some of the (limited amount of
good) researcfh. It seems to me that it is very unclear as to how
beneficial opiates actually are for pain in the long run, and that
the brain will actually sometimes adjust its mechanism for
registering pain in order to get opioids (neurochemically feed
itself -- your brain, in effect is on "the other team"). The
combination of these two factors occurs in many people apparently,
if the numbers of opioid addicts we have seen over the years is any
indication. The deaths continue to rise exponentially, death being
only one element of what's left in the wake of addiction. Pain is
subjective, difficult to prove. Pain meds may not actually work
over the long term, but people's brains neurochemically tend to
like them and want to keep them on board. Opiates are also mood-
altering, let's not forget. So how does any doctor know if the
person in front of them needs this drug this badly to warrant the
risk? They have to use their very best judgment. And given the lack
of evidence for longterm tx of chronic pain, and the high risk of
developing an addiction that could negatively impact a person's
quality of life, isn't a conservative stance best when it comes to
the prescribing of these drugs?.

CADAWASP RN CHPN

09/11/13

As a hospice nurse I
have encounter the
patient and family
fears of addiction
even when the person
is dying. Stories
like this one will
only make that fear
worse.
Understanding the
use of adjunt
medications with
opioids is very
important in the
care of of the
hospice patient and
all patients that
are having pain.
This is something
all hospice,
palliative and pain
professionals should
understand and use
in the care of
patients with pain.
Now I will speak as
a chronic pain
patient. I have
spinal stenosis and
have had multiple
surgeries on the
spine over many
years. I have also
been treated for the
pain by my wonderful
and caring pain
specialist. I use
both Neurontin and
Cymbalta for pain
and have VicodinER
for pain not covered
by the other
medications. I do
not take the
VicodinER frequently
and at times have
not used 180 pills
over the period of
one year. I have
had spinal blocks,
use Lidoderm
patches, tried TENS
and physical
therapy. I do not
know what would
happen if there was
a problem getting
the Vicodine ER
although this
article does not say
that this will
occur. I too have
had to sign
contracts, and
undergo urine
testing because of
the use of an opioid
(Vicodin). Misuse
can be avoided with
electronic
prescribing so
people who need the
opioid can still get
them because the
system should be
able to tell if
someone is doctor or
pharmacy shopping by
alerting the doctor
or pharmacist that
this is occurring.
This would help
prevent the chronic
pain patient from
feeling that they
are suspected of
drug abuse..

DrJJW

09/14/13

The amount of arguing about this article just verifies the scope of this problem in the USA. The fact remains that
the US. Prescribes far more narcotics per capita then any other country. You can't dismiss that fact. So we have
more people with chronic pain here? Or us it that many drs don't have the time to assess pt asking for these meds
and don't want the hassle they often create? How often do you have a pt come to your office screaming about
how they need their diabetic meds or HTN meds refilled Just like other disorders such chronic pain pt would be
best handled by pain mgmt specialist who can truly assess and treat the pt. that way those who need chronic pain
meds can be helped and those that abuse the meds can also be properly helped. Overloaded and overworked
primary care providers do not have the time to properly care for and monitor these pt but yet they are the ones that
have too a majority of the time. All to often these meds are started by another specialist then dumped on the PCP.
I'm sure if they had to deal with the problems of addicted pt on a daily basis there would be less inappropriate use
of these meds. I'm sure ill get a lot of slack for this message but that just proves my point.

Dr. Mike

09/15/13

All opioids induce tolerance. For oxycodone, hydrocodone, and
morphine tolerance begins in most people at doses between 30 to 50mg
total daily dose. Tolerance means that the opioid no longer has the
same pain relieving effect that it once did. Tolerance means that a
dose increase is necessary to achieve the same level of relief that
the opioid gave when first started. Tolerance means that there is
only a temporary benefit from the increased dose until it too loses
effectiveness. Tolerance means that when a dose is missed or delayed
there is pain above and beyond what would be felt had the patient
never been started on opioids in the first place. Tolerance means
that the patient has altered opioid receptors and is likely to
develop a fibromyalgia-like syndrome with with widespread pain
unrelated to the original pain for which opioids were prescribed.
(In my addictions work I note the same thing - patients who never
had pain before they started abusing opioids have pain now, and even
in the early states of withdrawal have significant pain).
I have had patients come to me on doses of 2000mg daily of morphine
equivalent opioids. They were still in pain, and still in about as
much pain as they always had been. They tolerated a dose reduction
(done intelligently) with no significant increase in pain upon
completion of the reduction process.
Tolerance is the one fact that everyone likes to forget. There is
no dose above the tolerance limit at which the patient is ever out
of pain. Studies show consistently that patients that take their
opioids on a more prn basis have greater quality of life. Their pain
scores show wider variance - i.e. as good as 4/10 and as bad as
9/10. They use the medication to their advantage to make desirable
activities possible. Patients on chronic long acting opioids like
oxycontin show lower quality of life - i.e. their pain scores are
consistently in the 7-8/10 range. They never have scores low enough
to make desirable activities possible, and yet the "10/10" pain they
experience during the withdrawal from a missed or delayed dose
convinces them the absolutely cannot live without their high dose
long acting opioid.
It is not possible to have an intelligent debate about opioids
without taking into account tolerance..

c darling

09/16/13

I read this and my first, second and last thought is the monkeys are
again running amuck. As a person with multiple genetic disorders and
diseases that lives in pain daily and my life is hell --I believe my
pain mgmt doc should be the one making my choices not some monkey in
a suit or some do gooder that can figure out how to sign a petition
instead of working for a living. I cannot take the oxy because it
kills the mitos. But God forbid us helping others out that are in
pain for real. I would love to line all the do gooders up against a
wall and ram with a car and let them heal with no pain killers -b/c
their pain is not real. Fools to the left of me, fools to the
right...not a damn good doctor with guts in sight..

Disgusted MD

09/16/13

Scenario: I have had Restless Legs Syndrome and Periodic Leg
Movement Disorder since childhood. As I have gotten older, they
have transformed from an irritation to incredibly painful,
disastrously relaxing and sleep disrupting disorders. Have been on
Klonopin for years, and, now on Hydrocodone. I consulted with a
prominent sleep neurologist and we tried every medication
indicated, hoping to get off the 'terrible' meds. Every doctor I
see, PCP, etc., lecture and yell at me, outright refusing to
prescribe either mediation, even when I never asked for it.
I suppose RLS and PLMD would not be considered chronic pain
disorders. I suppose if I went to a pain specialist, I would be
asked to take the gamut of antidepressants, antipsychotics,
anticonvulsants, etc. I cannot take antidepressants, and many
other classes of meds., as they make my symptoms much worse.
I have one physician prescribing the "objectionable" meds., I make
it clear to every doctor I see. I also have never abused them--in
fact I have actively sought decent detox programs to get off of
them, impossible when Medicare is one's primary insurance carrier.
I could comment on many postings on this page. One truly offends
me. To Dr. Mike: You read like an dull textbook. You can spout
off definitions, but patients are humans, not all have physiology
that follows your book of rules, etc. You wrote "In my addictions
work I note the same thing - patients who never had pain before
they started abusing opioids have pain now, and even in the early
states of withdrawal have significant pain". "Before they started
ABUSING opioids". Interesting choice of words. I have seen studies
posted on medpage showing that few pain patients taking opioids
actually abuse them. Are there exceptions? Of course. I sense
absolutely no compassion in anything you wrote, just a bunch of
definitions and references to the phenomenon of increased pain
sensitivity (Hyperalgesia--not the same as fibromyalgia, by the
way) sometimes experienced. ONE SIZE DOES NOT FIT ALL. ONE
TEXTBOOK RESPONSE/DEFINITION DOES NOT FIT ALL. We are talking
about human beings, not a bunch of data. If a patient has gone
through what one pharmacist referred to a the ladder of medications
for treatment of chronic pain as I have, then quit judging me for
having to take an opiate. I know full well the effects. I don't
like them, but they are preferable to the intense pain, sleep
deprivation caused by my disorders, and the 'evil' meds. allow me
to lead a semblance of a half decent life.
Remember the classic med. school interview question, Dr. Mike and
others? Is medicine a science or an art? It is both. Yes we need
to have a solid scientific background. We also need to remember
that not every patient fits the textbook, and not all are opiate
abusing noncompliant animals..

Dr. Mike

09/16/13

To Disgusted MD, You have not correctly distilled what I wrote. I
never suggested that opioids should not be used - they have a
definite role as the 500 patients with chronic pain that I manage
can attest. The addictions practice is generally for patients
without pre-existing pain, not for patients in need of opioids.
This is exactly consistent with your statement that pain patients
rarely abuse them. The point was the end result of chronic opioid
use, not the reasons for which they came to be used chronically.
And of course opioid hyperalgesia and fibromyalgia are dissimilar.
In my experience users of long acting opioids experience both. And
yes, essentially one size does fit all, in the sense that ALL homo
sapiens exhibit tolerance when exposed to long term long acting
opioids. Sorry, but no one is so special that they are immune to
this phenomena. If you feel judged it is not because of what I
wrote because qhs opioids for the condition you describe is exactly
the type of role I see for opioids and something I do a lot of. Try
reading again without adding what is not
there - namely that I see no role for opioids when in fact I do. It
is the 24/7 use of opioids that has scientific basis whatsoever..

Disgusted MD

09/16/13

Dr. Mike: I appreciate your response. I read again and I see your
point. I erred, and apologize, as you wrote of patients without
pre-existing pain I realize that tolerance is a huge issue.
However, if one must take opiates as nothing else works, talking
tolerance to a pain patient is almost moot, unless a working
alternative is possible. At that point, closely working with the
one and only treating physician is critical. Trust, feeling heard,
close work and monitoring are vital.
You write that 24/7 use has ?(no) scientific basis may be
scientifically valid. But, once again, telling that to a patient
for which no other medication has worked achieves what purpose and
elicits what response?
I must take my Hydrocodone on a scheduled basis, several times a
day (Not just qhs), 24/7, or I pay a dear price. I have been asked
to try everything on the RLS/PLMD med. list, including the hellish
Methadone. I am slowly tapering off, as much higher doses of
Mirapex have helped. I do not know if it will help enough to allow
me to completely stop the Hydrocodone. I hope so.
I am actually far more concerned and dismayed by the long term
effects of the other medication I am on, a benzo, having found NO
help in getting off of it, other than being told to substitute
another benzo for it, then tapering off that. I do not understand
why no fuss about the benzos, personally. UK websites are full of
information about the sometimes irreversible long-term effects that
doctors here deny.
This issue is a huge one. It has left many doctors unwilling to
prescribe opiates at all, fearing scrutiny. Pharmacists have
joined the bandwagon where I live and often refuse to fill
prescriptions for opiates. At refill time, I have to call around
to see which pharmacy I must use.
I would actually enjoy talking to you about these issues. Always
learning.....

Thomas Cohn, MD

09/16/13

Improving opioid prescribing is important, but the better starting point may be improving the
understanding of pain by doctors as well as patients. Doctors need more training, starting in medical
school and progressing throughout residency and practice. Read more of my thoughts here:
http://mnphysicalmedicine.com/2013/09/16/fda-increases-rules-for-opioid-prescribing-to-cut-
down-on-abuse/.

Thomas Sachy MD MSc

09/16/13

FDA added these statements to their letter regarding opioid
relabeling...They got it right...
1. "(The) FDA knows of no physiological or pharmacological basis
upon which to differentiate the treatment of chronic pain in a
cancer setting or patient from the treatment of chronic pain in the
absence of cancer, and comments to the Petition docket reflect
similar concerns. (The) FDA therefore declines to make a distinction
between cancer and non-cancer chronic pain in opioid labeling.
2. "'A one-size-fits-all’ approach to a maximum dose or duration of
treatment would be problematic and inconsistent with the need for
individualized treatment and the variability among patient responses
to opioids."
Nuff said!.

Dr. Mike

09/16/13

To Disgusted: The approach that Dr. Susan Ashton takes towards
getting people off of benzodiazepines really does work - I use her
method all the time with great success. Diazepam really is easier
to wean off of because it is very long acting and because it comes
in dosage forms that allow for tiny reductions. Clonazepam .5mg is
equivalent to 10mg diazepam - the diazepam comes as 2mg tabs
allowing a 1/10 reduction by taking 4.5 tabs instead of 5 tabs (9mg
instead of 10mg). Even quartering the Clonazepam leaves you with
too large of a reduction to tolerate. The key is a motivated
patient who understands that they get to set the pace of weaning,
not the doc. They wean when they are ready, and wean as fast or
slow as they can tolerate. It may take a year, but it works, and
patients always thank me for being on one less pill and for the fog
that has lifted that they didn't realize was there. They think more
clearly and process more quickly. The risk of benzos + opioids is
real and significant, not to mention the 60% risk of dementia for
chronic benzodiazepine users...(read the article in British Medical
Journal Oct 2012 - google "bmj benzodiazepines dementia")
As to hydrocodone vs. long acting - it is fairly difficult to get
true 24/7 coverage with hydrocodone, and that is what saves you.
Give your opioid receptors a break now and then and they will reward
you by remaining more or less responsive to the pain relieving
properties of the opioid..

Disgusted MD

09/18/13

Dr. Mike: Thank you for your thoughtful response. I am truly
grateful. I feel so much validation by what you wrote, wish I had
found someone as compassionate and understanding of the weaning
process. I simply got reminded how the drug is out of my system
after 4 half-lives and I should not be having problems. I have
been forced to respond for them to tell that to my screaming GABA
receptors.
I have read of C. Heather Ashton (Same person you are referring
to?), her webpage:
http://benzo.org.uk/manual/bzcha02.htm. She explains how to get
off the benzos by switching to longer acting ones, as well.
I have had doctors tell me to switch to Ativan and taper off.
Switch to dose ratio of 1:1. It made no sense. Was told I could
be off of it in 30 days, when I know it can take a year or more of
tapering and still experience hellish withdrawal. I could not get
anyone to listen to me about the above British website.
I had been tapering off the Klonopin for almost 2 years and had cut
my dose by almost half. Problematic, as, at the same time, I had
to find better treatment of the RLS/PLMD or no taper possible. I
decided to taper of the Hydrocodone first, thinking it would be
easier. I have drastically cut the doses, it has not been easy.
You speak of the brain fog. Yes! And emotional volatility. It
has cost me. I would tell anyone to never start taking a benzo.
They are meant for short term treatment, not years. Dr. Ashton's
website has shocking stories, and she details the collateral damage
done by benzos, I think. I know others have documented it. No one
hears me when I bring it up.
From a page on her sight: http://benzo.org.uk/nicks.htm
Stevie Nicks: "[Klonopin] turned me into a zombie,” she told US
Weekly in 2001.....She "said that her eventual 45-day hospital
detox and rehab from the drug felt like "somebody opened up a door
and pushed me into hell."
My fear when I resume the benzo taper is the withdrawal, dealing
with it alone, no professional support as few (good) therapists,
addiction specialists in my area take Medicare. I am concerned
that after ~20 years on it for the RLS/PLMD, tapering will/and has
unmasked much anxiety. So I go slowly, one med. at a time. One
sliver at a time, by myself. I want a clear mind again.
I will try your regimen when done with Hydrocodone..
Thank you..

kevin burke

09/18/13

In my humble opinion, this is simply another example of the DEA teaming up with the FDA to place unnecessary
restrictions on medications. Probably the greatest reason that opiates are being used for chronic pain is that we
now have controlled studies confirming the efficacy of pain control with opiates. My fear is that the more restrictive
labeling on ER and LA formulations of opiates will result in needless suffering. Who is to judge what constitutes
"moderate" vs "severe" pain? Why aren't the labels of all opioid analgesics being changed? Aren't they all a part of
this alleged "epidemic"?
Any reputable prescriber of opiate pain meds would - and already does - put safeguards in place. Random urine
screens, periodic tablet counts, opioid contracts all serve to ensure the patient is carefully monitored. Additionally,
the requirements of all drugs in Schedule II provide control. It's time that the DEA stops using scare tactics on
doctors by enlisting the FDA as its wingman. Leave the prescribing to those who have studied and practiced it..

Scott D. Mueller, MD, FAAFP

09/18/13

Is chronic pain
really a huge
problem in the US?
Are there more
people in chronic
pain then people
with cancer,
diabetes, and high
blood pressure
combined? If so
then doesn't it make
sense that the best
pain killer known ie
opium is prescribed
in such large
amounts? Someone
stated that
Americans use more
opiates than the
rest of the
world--we also
probably have more
TVs per capita, does
that mean we are
abusing TVs (not
saying we don't have
a problem watching
too much TV)? We are
a wealthy nation and
can afford health
care and TVs. I
fear regulatory
oversight. I am
limiting my
prescribing of
opiates. Sure we
can prescribe off
label but if
something goes wrong
with a patient what
will come back to
haunt you?--the
medication labeling.
I really don't see
any end in sight to
this problem.
Patients will suffer
until a medication
is developed that
works as well as an
opiate or better and
cannot be abused.
Doctors need to take
the initiative and
society needs to
give us the
authority to
regulate ourselves
as doctors in a
peer-reviewed
environment so that
we don't have to
fear the harsh
penalties that can
be inflicted by a
faceless review
board unless the
physician truly
needs punishment as
determined by peers
that know the
doctor..

Kevin Witbrodt, PharmD

09/24/13

To VS87:
My comment wasn't meant to take any one side on the matter. I'm sorry you read me that way. All I'm pointing out was that I don't think the label change will affect prescribing opioids. The latter part of my previous comment was just to indicate that there are "some" doctors who will write opioids without first trying other alternatives. I have seen several patients with RA and several with cancer and know the importance of opioids in their lives, but we must all agree that there are some individuals out there with pain that can be managed appropriately without the aid of opioids. Once again sorry if I offended anyone with my comment before but this is just my experience..

Kevin Witbrodt

09/24/13

To VS87: I realize the part that may have been offensive about opioids and arthritis. In the context of my comment I meant to suggest that opioids for treatment of OA or RA shouldn't be taken lightly. With RA I was suggesting at treating the inflammatory process to help treat the pain before jumping to a narcotic...same goes for OA and trying straight Tylenol or other non-narcotic first. I would never mean to infer that we limit pain treatment, I just mean to take a stepwise approach..

James Tigges

10/25/13

I trained as an MD gave up my practice to train and now own my own pharmacy, I am also a chronic pain sufferer due to demyelination of my peripheral nerves from C2-T5, 1/3rd of my body no longer works, muscle wasting, permanent dislocated shoulder, to name just a few of my problems.
I know narcotic diversion is a problem but let's not make it impossible for genuine pain suffers have to jump through hoops to get needed meds..

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